Toward an integrated approach for addressing malnutrition in Zambia

A literature review and institutional analysis

Due to the predominance of direct, specific interventions in nutrition for development, the health sector tends to own nutrition, with interventions customarily implemented through health programs. The idea that the agriculture sector should also be a vehicle for improved nutrition is intuitive, but this sector often delivers neither good nutrition nor food security to the most vulnerable in the population. The complex and multisectoral nature of malnutrition may explain why it has not been effectively addressed, even though we know many of the solutions; intersectoral action is critical to addressing this complexity, but to date there is no consensus on how intersectoral solutions are best implemented or institutionalized. This review brings together experiences from across Sub-Saharan Africa in order to draw out recommendations for improved intersectoral implementation going forward, and assesses how these findings apply specifically to the Zambian context.

The experiences reviewed suggest three broad barriers to intersectoral collaboration for nutrition: low political commitment and mobilization; sector-bound organizational structures and weak coordinating bodies; and lack of human resources and capacity. Key lessons for improved intersectoral implementation include the role of advocacy in framing the problem in context and highlighting mutual gains for different sectors, to create the political will and working space for nutrition action; the importance of organizational arrangements, including convening or coordinating bodies with multisectoral credibility to facilitate mobilizing and resourcing power; and the importance of building not only technical but also strategic capacity to manage multisectoral relationships for improved nutrition outcomes. Ultimately, these solutions will have to be tailored to country contexts.

Zambia is an ideal candidate for a country that could make a significant impact on its malnutrition problem. With the emergence of the Scaling Up Nutrition (SUN) movement in the country, nutrition has received some high-level political attention, and the multi-sectoral nature of nutrition is recognized in overarching development policies and strategies. However, political attention has not moved into concrete action, and nutrition strategies, policies, and plans are essentially wish lists noting best practice, confined mainly to the health sector, created with substantial input from external actors, and without the backing of political commitment, budgetary or human resources, or capacity; implementation of these grand ideas is severely lacking. Several vital but attainable processes would improve intersectoral coordination for nutrition in Zambia and enable its potentially strong policy to be implemented across sectors. These include strategic lobbying for real political and social commitment to nutrition in sectors outside of health; strengthening the National Food and Nutrition Commission both in terms of its power to convene the different actors and the strategic capacity of its leadership; and improved technical training outside of core nutrition competencies in nutrition workers in general. These recommendations are interlinked; one cannot happen without the other, and all are necessary but not sufficient to improve the nutrition situation in Zambia. Movement should start in all areas at once, and the high-level momentum created by the SUN movement is an opportunity, providing the potential for cross-sectoral dialogue and increased resources, that should not be missed.